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Introduction
A nationwide rollout of digitalised patient records is expected to occur by 2026, according to an announcement by the Health Minister in May 2023. The effort to implement an electronic medical record (EMR) system is not new to Malaysia, as the country has attempted to include an EMR component in some of its public hospitals since the 1990s.
The Khazanah Research Institute (KRI) has previously advocated the implementation of a comprehensive national system that allows electronic sharing of health records across facilities. Instead of focusing on investments towards advanced healthcare technology such as surgical robots that would benefit a small population of citizens, a national digital health records system is a basic technological investment that would potentially improve patient care for all.
Accessing health records anywhere, anytime
People receive care from several different healthcare providers throughout their lives. This includes regular interactions with primary care clinics (klinik kesihatan (KK)), annual visits to dental clinics as well as occasional visits to hospitals.
Thus, it is important for patient information generated at each point of care to be digitally recorded and updated in a centralised database. With a digitalised health records system, patient data such as previous diagnoses, allergies, test results and current medications would be accessible no matter which health facility a patient visits.
Despite debates on whether the term EMR should be used to refer to such a system or if the term electronic health record (EHR) is more accurate, the final goal of the Ministry of Health in Malaysia (MOH) is clear. It envisions a shareable digital record of patient health that would follow a patient throughout their lifetime.
Comprehensive records, continuous care
Digitalising health records is a step towards ensuring that continuous and accessible routine care is made available to Malaysia’s ageing population, especially those burdened with noncommunicable diseases (NCDs) such as diabetes and obesity.
Accessing digital health records could improve care delivery by making healthcare providers aware of a patient’s condition when administering emergency care. Patients with chronic NCDs would also be empowered to understand their condition and take care of themselves more effectively at home.
In the United States (US), patients over 65 years old were found to have higher compliance to their treatment plan and medications when provided access to their personal health information. Improving a patient’s ability to manage their disease has been shown to reduce the burden on the healthcare industry, both in terms of cost and human resources.
Digitalisation as an aid to health protection
Over the years, disease patterns have changed significantly and NCDs have become the major cause of poor health in Malaysia. In 1990, NCDs made up 60% of total health loss but in 2019, they made up almost 74%. Common causes of NCDs are largely preventable, given the right investments in preventive and promotive health services such as cancer screenings. However, Malaysia currently faces a worryingly low uptake of cancer screening programmes which has been attributed to the lack of up-to-date screening registries.
An EMR system with real-time updates of patient data could act as a comprehensive patient registry that allows effective targeting of populations eligible for healthcare screening. In the future, this digital patient record system could be linked to a National Social Protection Registry to optimise not only healthcare delivery but also the channelling of social security services.
Need to focus on minimising risks
It is important to note that introducing digitalised patient records does not come without risks or challenges. MOH has acknowledged that an integrated health database system may face ransomware attacks. Stringent data governance and data security protocols need to be of the utmost priority when implementing the EMR system.
User-friendly design and low-tech backup alternatives are also crucial when considering a nationwide system that involves different levels of digital literacy, infrastructure and human resources. Previous hospital digitalisation efforts in Malaysia have faced patient safety issues. This has been attributed to a lack of knowledge in using the system and insufficient computer resources as well as high workloads leading to incorrect data entry.
MOH appears to be taking these issues into consideration in the current rollout, given the Minister’s announcement of a lighter, web-based records system for public clinics that lack hardware and infrastructure.
Putting in place a digital system is also only the first step. The next challenge lies in ensuring system inclusivity, taking care to address inequalities in digital access and literacy within the population. Outreach and education programmes need to be implemented to empower patients to access and utilise their health data.
Balancing the double-edged sword of digitalised patient records
The implementation of a digitalised health records system will require a fine balance between improving efficiency and continuity of care while mitigating risks to privacy and security. Since Malaysia is still in the early stages of nationwide implementation, it is an opportune time to call for careful evaluation of the rollout process to avoid putting in place a poorly-designed and costly system. KRI’s forthcoming work will discuss an idealised digital patient records system framework in more detail.
